In February, the World Bank delayed a $90 million loan for health care in Uganda out of concern over its new Anti-Homosexuality Act. Since then, the Constitutional Court nullified the law for lack of a parliamentary quorum during the vote. But the government quickly filed a notice of appeal. Members of parliament are also pressing to bring the law back to the floor, swearing they can gather the constitutionally-required numbers.
Just as troubling, another law came into force in July that criminalizes even unintentional HIV transmission and requires HIV testing of pregnant women without their consent, and forced disclosure.
In a personal and thought-provoking Washington Post op-ed earlier this year, World Bank President Jim Kim said that discrimination is bad for economies, societies, and individuals. It can prevent people from fully participating in the work force and discourage multinational companies from investing or locating activities in countries with discriminatory laws, he said.
Implicit in the message was that discrimination is bad for governments receiving development assistance too. It would appear that President Yoweri Museveni is also starting to understand the economic cost of anti-equality policies, but his rhetoric has been inconsistent. The World Bank/International Monetary Fund annual meetings in Washington this week give President Kim a critical opportunity to stand up for these concerns and push Uganda’s government to take meaningful steps to address discrimination in health services.
The frequently reported discrimination in Ugandan health centers against sex workers and gay men discourages people from seeking care. Prime Minister Ruhakana Rugunda, the former health minister, in August admitted to two groups that discrimination exists and that the government is not equipped to monitor or respond to it.
Last week, in a letter to President Kim, 16 Ugandan and international organizations laid out enforceable steps the bank should take to see that discrimination in care for marginalized groups ends before releasing the loan. Steps include requiring the government to prohibit discrimination in healthcare delivery on grounds of gender, sexual orientation, gender identity, and all other grounds articulated under international law, and requiring government health care workers to respect patient confidentiality, privacy, and informed consent to all treatment.
The World Bank should also fund activities to promote patients’ rights, including providing patient advocates and legal counsel for people who face discrimination, breach of confidentiality, or other abuses in health settings and training for Ugandan health workers to respect these rights. The groups also pressed the bank to urge the government to guarantee that it wouldn’t interfere with independent monitoring of health services.
It is crucial for the World Bank to urge the Ugandan government, publicly and privately, to repeal all discriminatory laws and end discriminatory practices. The bank should emphasize the importance of non-discrimination for health and economic development.
After 28 years in power, President Museveni is gearing up to run again in 2016. Aid has continued to flow despite large-scale corruption scandals, but this time should be different. The bank’s decision on the loan will affect the bank’s credibility in Uganda and beyond.
President Kim’s statement about the deleterious economic impact of discrimination was a precedent-setting decision to stand up for human rights. Pushing for real safeguards could significantly contribute to mitigating discrimination against LGBTI patients, women, and other marginalized populations who are at disproportionately high risk of negative health outcomes and poverty.
Releasing the loan without meaningful safeguards, while Uganda’s parliamentarians continue to pass discriminatory laws and urge more discriminatory measures, would show a profound disregard for President Kim’s clarion call.
Maria Burnett is a senior Africa researcher at Human Rights Watch.
